Individuals with chronic ankle instability (CAI) have been shown to have increased lateral plantar pressure during walking which is thought to contribute to symptoms associated with CAI. The objective of this study was to determine whether real-time video feedback can reduce lateral plantar pressure in individuals with CAI. Twenty-six participants with CAI completed 30 s of treadmill walking while plantar pressure was measured using an in-shoe plantar pressure system (baseline). Next, participants completed an additional 30 s of treadmill walking while receiving video feedback (VID FB). During the VID FB condition, participants had a significant decrease in medial forefoot peak pressure and medial midfoot pressure-time integral; however, both changes were associated with small effect sizes. Real-time video feedback did not reduce lateral plantar pressure in individuals with CAI; therefore, other gait retraining strategies should be considered when treating patients with CAI.
Context: Altered biomechanics displayed by individuals with chronic ankle instability (CAI) is a potential cause for recurring injuries and posttraumatic osteoarthritis. Current interventions are unable to modify aberrant biomechanics leading research efforts to determine if real-time external biofeedback is capable of producing changes.
Objective: Determine real-time effects of visual and auditory biofeedback on functional task biomechanics in individuals with CAI
Design: Crossover study
Setting: Laboratory
Patients or Other Participants: Nineteen physically active adults with CAI (23.95±5.52 years; 168.87±6.94 cm; 74.74±15.41 kg, female=12) volunteered.
Intervention: Participants randomly performed single-leg static balance, step-downs, lateral-hops, and forward-lunges during a baseline and two biofeedback conditions. Auditory biofeedback was given through a pressure sensor placed under the lateral foot connected to a buzzer eliciting a noise when pressure exceeded the set threshold. Visual biofeedback was given through a cross-line laser secured to the dorsum of the foot. Cues given during the biofeedback conditions were used to promote proper biomechanics during each respective task.
Main Outcome Measure(s): Location of center of pressure (COP) data points during balance with eyes-open and closed during each condition. Plantar pressure during functional tasks were extracted in the lateral column of the foot. Secondary outcomes of interested were COP area and velocity, time-to-boundary during static balance, and additional plantar pressure measures.
Results: Both biofeedback conditions reduced COP in the anterolateral quadrant while increasing COP in the posteromedial quadrant of the foot during eyes open balance, the auditory condition produced similar changes during eyes closed trials. Auditory biofeedback increased heel pressure during step-downs, while decreasing lateral forefoot pressure-time integral during lunges. Visual biofeedback increased lateral heel pressure and increased lateral heel and midfoot pressure-time integral during hops.
Conclusions: Real-time improvements in balance strategies were observed during both external biofeedback conditions. Visual and auditory biofeedback appear to effectively moderate different functional task biomechanics.
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